An introduction for the treatment and educational strategy of medically unexplained symptoms in Denmark

The treatment for medically unexplained symptoms (MUS) remains problematic1,2 especially in the primary care field. The problems come from the confusion of the terminology,3-5 the difficulty of communication with them.6 We can see several trials for the better treatment for MUS7 in Denmark, including the educational program for general practitioners (GPs)8 or some group psychotherapies.9-11 The educational program is called as the extended reattribution and management model for functional disorders (TERM),12 and is applied nationwide in Denmark. It explains GPs how to understand, how to communicate, how to treat or manage these patients.13 In this paper, TERM was overviewed and discussed on its meaning in the clinical practice in Japan, based on the literature review. The literatures were overviewed by PubMed for recent 10 years with the key word of medically unexplained symptoms. The patient’s satisfaction to the health care services depends on human relation not on the quality of care,14 or it depends on the national budget for the health care service.15 Denmark has the universal health care system financed by taxes, where the residents can perceive health care services basically free or with small charge.16 When it comes to the health care related spending, a share of GDP is 10.4% in Denmark, 10.2% in Japan.15 The major difference between us is that Denmark has the registered doctor system,16,17 while Japan has the free access system.18 The resident in Japan visits the doctor 12.9 per person per year, while it is 4.7 in Denmark.19 However, the number of consultations don’t always relate to the patient’s satisfaction. Ninety % of the respondents in Denmark are either satisfied or very satisfied with the health care services.20 The mismatch between the doctor and the patient (Table 1) can also cause dissatisfaction to the consultation.6 And the therapeutic structure or the communication between the doctor and the patient is also important21-23 in the treatment of MUS patients. TERM12 focuses just on the relationship and consists of five components13 (Table 2). Step A is the patient’s part which focuses on making the patient feel heard and understood. Step B is the doctor’s part, and the doctor should provide feedback on the results of the physical examination as an expert. And it continues to Step C, D, E. In this way, TERM summarizes the important communication techniques and leads to the better understanding for the patients. According to the outcome survey, TERM doesn’t improve the symptoms of MUS patients, but it improves the GPs’ attitude and reduce the anxiety to see these patients.24,25 TERM is supposed to be a good educational tool for the GPs who treat and manage MUS patients. Now the health care system in Japan has an economical challenging,18 it is just the time to shift the therapeutic focus from the pharmacotherapy or excessive clinical examinations to the relationship between the doctor and the patient. TERM will help us to facilitate such a trend.